The last time that a congress and President Donald Trump controlled by the Republicans moved to the expenditure of Medicaid, stood in the way of an important political strength in 2017: Gop-Gouverneurs.
Now, while the congress is steaming for the passing of historical medicaid cuts of approximately $ 1 trillion in 10 years Due to Trump’s tax and spending legislation, the Governors of Red-State do not publicly say what it does against health care if they are confronted with reductions that will hit the gaps of millions of dollars in the budgets of their states.
Medicaid, a program that is run together by states and the federal government, covers more than 70 million people with a low income or disabled people, including almost half of the children of the country. Republicans say that the program of $ 900 billion a year would become too great under Democrats Barack Obama and Joe Biden by adding non-disabled adults they say Do not earn help from the governmentAnd they have tried to scale it back for a long time.
Some of the greatest health releases in the legislation that Trump calls the “one big great account” are achieved by a new policy that would reduce the registration by imposing more paperwork requirements on registrations, including a requirement that many prove that they work. That policy would only influence states that have extended Medicaid to more people with a low income under the Affordable Care Act.
Nineteen of those states are Led by Republican Governors. Their silence about the health measures of the bill is giving political coverage to GOP laws from their states, because they try to reduce Medicaid coverage for millions of people who have received it over the past decade.
KFF Health News contacted all 19 governors for comments on the Medicaid cuts of legislation. Only six responded. Most said they supported the imposition of a work requirement on Medicaid -ing -written adult medicaid.
“Implementing work requirements for valid adults is a good and necessary reform, so that Medicaid is used for temporary help and no permanent right,” said Drew Galang, a spokesperson for Gov. Patrick Morrisey from West Virginia.
“Governor Rhoden supports participation of the workforce as a requirement of Medicaid extension,” said Josie Harms, a spokesperson for South Dakota Gov. Larry Rhoden, adding that congress legislators have the support of the Governor on the support of the governor: “South Dakota has an excellent federal delegation and governance they have to deliver the government’s government.”
In a sign of how the political winds have changed, none of the governors said anything about one of the important cuts of legislation, to taxes suppliers – a tool that all their states use to pay their part of Medicaid and to win extra money from the federal government. That change is expected to cost billions.
No longer a twofold problem
In contrast to the radio silence of GOP governors, Democratic Governors campaigned against the Megabill for weeks.
Pennsylvania Gov. Josh Shapiro posted On the social platform X That Trump and congress republicans mislead Americans by saying that they only cut waste, fraud and abuse in Medicaid.
“They rush to kick hundreds of thousands of Pennsylvanians of their health care – and lie about it,” he placed. “The damage that this will cause here in Pennsylvania and throughout America is amazing and will be felt for years to come.”
In New York, Gov. Kathy Hochul on 1 July that Trump’s legislation would destroy hospitals and lead to more than 34,000 job reductions in its state.
“The collective impact of the Gop -Zoningwet in Washington, DC, could force hospitals to limit critically required services such as pregnancy care and psychiatric treatment, and not to forget to reduce the operations and even close it completely,” she said, “she said in a statement.
In 2017 the choir was two -part, as Republican Governors in Ohio” NevadaAnd Massachusetts spoke against cutting medicaid. Trump’s bill to withdraw a large part of the affordable care act and roll back the Medicaid extension failed scary in the Senate.
“It was surprising that regulators in Red-State, in particular those in Medicaid expansion states, did not express themselves to Medicaid debit,” said Larry Levitt, Executive Vice President for Health Policy at KFF, a non-profit organization for health information with KFF Health News. “Republican governors were a powerful political force in the failed effort of 2017 to withdraw and replace the ACA, including Medicaid extension.”
What has changed since 2017, say policy experts are that there are less moderate republican governors, and Gop -State leaders who argued for Medicaid more than ten years ago are no longer in office.
Moreover, seven of the then states that have expanded Medicaid are Did this through Ballot InitiativeUsually above the opposition of their governors.
In fact, the Medicaid -Work requirement is supported by many Republican Governors, even if it means less federal medicaid money and leads to less covered people.
Various states, including Arkansas and Ohio, have already adopted the national laws to implement a requirement that adults have registered under the ACA’s medicaid expansion work, volunteer, going to school or participating in a job education. Most states still have to flourish work requirements programs because they are waiting for the federal government’s approval.
Charles “Chip” Kahn, president of the Federation of American Hospitals, a trade group of investors of hospitals, said that although fewer governors have been publicly involved in blocking Medicaid dehumors under the bill, federal legislators hear of legislators in their states.
A political dilemma for Republican governors is that, unlike in 2017, the bill for the congress is not legislation that is explicitly aimed at withdrawing Obamacare. With a reach that is broader than healthcare, it would expand much of Trump’s tax cuts and billions in new editions for border protection, immigration enforcement and the army, while also reducing the expenditure on health care.
“It’s like playing multidimensional chess instead of concentrating on one problem,” said Kahn.
Larry JacobsDirector of the Center for the Study of Politics and Governance at the University of Minnesota, said that some Republican Governors may have been concerned about the Gop Senators of their states, but do not publicly express themselves for fear of drawing Trump’s Toorn.
“Why are they Cagey? Trump and don’t want to be” Liz Cheney’d, “said Jacobs, referring to the Republican former Wyoming legislator who helped Trump to help after she was vice -chairman of his attempts to destroy the results of the 2020 elections.
Walking political regions
The political hazard Republican legislators are confronted with publicly challenging Trump, remains explicit. On June 29, Senator Thom Tillis (RN.C.) announced that he would not run for re -election after he had expressed concern about the bill and the president threatened to support a primary challenger. Tillis was one of the three GOP people to vote against it on July 1, although it was still taken scary.
In addition to the work requirement, the largest medicaid cuts in the bill stem from the restrictions on taxes – levies that impose states on hospitals, nursing homes and other healthcare institutions to help their federal reimbursement compensation. Much of the extra money is then returned to the care providers in the form of higher payments for their Medicaid patients.
The practice, which is assumed in every state except Alaska, has been criticized by some Beltway Republicans as “money laundering” – although the taxes are approved by state laws and the federal centers for Medicare & Medicaid services and for decades under federal legislation.
The Senate bill would limit the money statements, could collect an increase – a movement that would mean billions in cuts on states and their hospitals.
The States with Republican Governors who have expanded Medicid, are Alaska, Arkansas, Idaho, Indiana, Iowa, Louisiana, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, Uth Dakah.
One of the governors who expressed concern about withdrawing the Obamacare Medicaid extension in 2017 was Jim Justice of West Virginia, at the time a Democrat.
In one Letter June 2017 To West Virginia Sen. Shelley Moore Capito, a Republican, wrote Justice: “Since so many of our people count on Medicaid, every cut would destroy Medicaid families in West Virginia.” He added that “the consequences were outside of catastrophic.”
On July 1, Justice – last year as Republican in the Senate – voted for the Megabill van Trump, including the Medicaid cuts.
“The Senator is of the opinion that this bill finds a good balance between protecting the most vulnerable and those who trust the program, while they deport waste, fraud and abuse to ensure that the program is implemented efficiently for those who earn it,” said William O’grady, a spokesperson for the judiciary, 2 July.
KFF Health News correspondent Arielle Zionts has contributed to this report.
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